| Objective:(1)To observe the clinical efficacy of Bushenhuatan decoction combined acupuncture and Bushenhuatan decoction in the treatment of Endometrial receptivity in patients with polycystic ovary syndrome of kidney deficiency phlegm stasis and compare the differences of effect between the two kinds of treatments,so as to provide a better project to improve the Endometrial receptivity in patients with PCOS of kidney deficiency phlegm stasis.(2)Exploring the mechanism of Bushenhuatan decoction to improve Endometrial receptivity in patients with PCOS based on GEO database and network pharmacology,So as to provides scientific data for further animal experiments and gene analysis.Method:(1)clinical observation: the cases were from the patient of gynecology clinic of hubei provincial hospital of traditional Chinese medicine from February 2018 to October 2019.The 60 cases of patients with polycystic ovary syndrome of kidney deficiency phlegm stasis who met the inclusion criteria were randomly divided into acupuncture and medicine group ?medicine group,with 30 cases in each group.The acupuncture and medicine group was treated with Bushenhuatan decoction combined acupuncture.medicine group was only treated with Bushenhuatan decoction.After continuous treatment for 3 menstrual cycles,observe and compare the result of TCM syndrome score,menstrual condition,endometrial thickness in Luteal phase,endometrial type,PI,RI,Salle score,LH,FSH,LH/FSH,T.(2)network study: Setting the key words as “Polycystic ovary syndrome”?“Endometrial Receptivity”“Homo sapiens”in GEO database;searching and downloading gene chip data associated with polycystic ovary syndrome and Endometrial receptivity,dealing with gene chip data by R software to get the different Endometrial tissue genes between the women with polycystic ovary syndrome associated with Endometrial receptivity and the normal women;obtaining the target genes of the effective chemical components in Bushenhuatan decoction through TCMSP database.The different genes of the disease and the target genes of the drug were intersected to obtain common genes.Exploring the mechanism of Bushenhuatan decoction to improve Endometrial receptivity in patients with polycystic ovary syndrome by analyzing common genes through disease-drug interaction network,the topology analysis,the analysis of GO biological processes,the analysis of KEGG pathway.1.Clinical observation(1)comparison of TCM syndrome scores: Intra-group comparison :there was no statistically significant difference in scores of dizziness and tinnitus(P>0.05),and the scores of lumbar tenderness,knee tenderness,limb fatigue,chest distress reduced,with statistically significant difference(P<0.05).Comparison between groups after treatment: the scores of acupuncture and medicine group is lower than that of the medicine group in lumbar tenderness,knee tenderness and fatigue,with statistically significant difference(P<0.05),and there was no statistically significant difference in scores of chest depression(P>0.05).(2)comparison of menstrual conditions: Intra-group comparison: the menstrual cycle,and menstrual volume were all improved.And there was statistically significant difference(P<0.05).Comparison between groups after treatment: there was no statistically significant difference between the change of two groups in menstrual cycle and menstrual period(P >0.05).The data of menstrual volume of acupuncture and medicine group was better than The data of medicine group,and there was statistically significant difference(P<0.05).(3)comparison of ultrasound results: Intra-group comparison : The data of endometrial thickness,PI and RI were all improved compared with before treatment and there was statistically significant difference(P<0.05).The proportion of type A and type B in endometrium morphology increased,and the difference was statistically significant(P<0.05).Salle score increased with statistically significant difference(P<Results:0.05).Comparison between groups after treatment: the number of PI and RI in the acupuncture and medicine group were lower than those in the medicine group,and the difference was statistically significant(P<0.05).Salle score in the acupuncture and medicine group was higher than that in the medicine group,and the difference was statistically significant(P<0.05).There was no significant difference in endometrial thickness and endometrial shape(P>0.05).(4)comparison of serological results: Intra-group comparison:the data of LH,LH/FSH,T in the acupuncture and medicine group ?medicine group were significantly lower than before and the difference was statistically significant(P<0.05).the data of FSH showed no significant difference(P>0.05).Comparison between groups after treatment: there was no statistically significant difference in the data of LH,LH/FSH,T and FSH after treatment(P>0.05).2.network research Getting 186 different disease genes through GEO database and R software,obtaining 263 target genes of the effective chemical components in Bushenhuatan decoction through TCMSP database.obtaining eight common gene of disease and Bushenhuatan decoction by dealing with different disease genes and drug target genes.Effective chemical composition are: quercetin,kaempferia galanga phenol,soy flavin,matrine,and so on;It is found in duzhong,tusizi,xiangfu,shanyao,gouqizi,cheqianzi.Disease-drug interaction network and the topology analysis were carried out to obtain the core genes;CCNA2,CCNB1,ICAM,CDK1.There were 432 GO biological pathways and 6 KEGG metabolic pathways by the analysis of GO biological processes,the analysis of KEGG pathway.Conclusion:(1)clinical studies have shown that Bushenhuatan decoction combined with acupuncture and Bushenhuatan decoction can improve Endometrial receptivity in in patients with polycystic ovary syndrome of kidney deficiency phlegm stasis,especially in the improvement of endometrial thickness,type,PI,RI and menstrual status.Moreover,the acupuncture and medicine group was better on improving PI,RI and menstrual volume.Both of the two treatment methods can significantly improve the patients' clinical symptoms of lumbar soreness,knee soreness,limb fatigue,and chest depression.the acupuncture and medicine group has more advantages in improving the symptoms of lumbar soreness and knee soreness,limb fatigue.At the same time,both methods can reduce the level of LH,LH/FSH and T.(2)ICAM is closely related to Endometrial receptivity in polycystic ovary syndrome patients,which may be a target for improving Endometrial receptivity and molecular marker for diagnosing Endometrial receptivity deficiency in polycystic ovary syndrome patients.Bushenhuatan decoction can improve Endometrial receptivity by regulating TNF signaling pathway through the active ingredients of duzhong,tusizi,xiangfu,shanyao,gouqiazi and cheqianzi,such as quercetin,kaempferol,flavanthin,matrine and luteolin. |
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